Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | Research article

Local control of giant cell tumors of the long bone after aggressive curettage with and without bone cement

Authors: Zhen-hua Gao, Jun-qiang Yin, Xian-biao Xie, Chang-ye Zou, Gang Huang, Jin wang, Jing-nan Shen

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

Login to get access

Abstract

Background

Aggressive curettage has been well established for the treatment of giant cell tumors (GCTs) of the bone. The purpose of this study was to review our experience and evaluate the role of different implant materials in patients with GCTs of the extremities after aggressive curettage.

Methods

A total of 119 patients with GCTs of the long bone were treated at the First Affiliated Hospital of Sun Yat-Sen University between 2004 and 2009. We excluded patients presenting metastases, recurrent tumors, and soft tissue involvement and those with Jaffe pathological grade III. The remaining 65 patients were treated with aggressive curettage using a bone graft or bone cement to fill the cavity. The recurrence rates and functional scores associated with the different fillings were analyzed.

Results

Aggressive curettage and bone grafting was performed in 34 cases (52.3%), and aggressive curettage with bone cement was performed in 31 cases (47.7%). The overall recurrence rate after the aggressive intralesional procedures was 35.3% with bone grafting and 12.9% when bone cement was used as an adjuvant filling. The recurrence rate following aggressive curettage and bone grafting was higher than that following aggressive curettage with cement (p = 0.038). The Musculoskeletal Tumor Society (MSTS) score for bone graft patients was 91.1%, which was significantly lower than that for patients treated with bone cement (94.7%).

Conclusions

The use of bone cement was associated with a significantly lower recurrence rate than bone grafting following aggressive intralesional curettage to treat benign giant cell tumors of the long bone. Better MSTS functional results were also observed in the bone cement group compared to the bone graft group.
Appendix
Available only for authorised users
Literature
1.
go back to reference Campanacci M, Baldini N, Boriani S, Sudanese A: Giant-cell tumor of bone. J Bone Joint Surg Am. 1987, 69: 106-114.PubMed Campanacci M, Baldini N, Boriani S, Sudanese A: Giant-cell tumor of bone. J Bone Joint Surg Am. 1987, 69: 106-114.PubMed
2.
3.
go back to reference Domovitov SV, Healey JH: Primary malignant giant-cell tumor of bone has high survival rate. Ann Surg Oncol. 2010, 17: 694-701. 10.1245/s10434-009-0803-z.CrossRefPubMed Domovitov SV, Healey JH: Primary malignant giant-cell tumor of bone has high survival rate. Ann Surg Oncol. 2010, 17: 694-701. 10.1245/s10434-009-0803-z.CrossRefPubMed
4.
go back to reference Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP: Giant cell tumor of bone. Am J Clin Oncol. 2006, 29: 96-99. 10.1097/01.coc.0000195089.11620.b7.CrossRefPubMed Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP: Giant cell tumor of bone. Am J Clin Oncol. 2006, 29: 96-99. 10.1097/01.coc.0000195089.11620.b7.CrossRefPubMed
5.
go back to reference Raskin KA, Schwab JH, Mankin HJ, Springfield DS, Hornicek FJ: Giant cell tumor of bone. J Am Acad Orthop Surg. 2013, 21: 118-126. 10.5435/JAAOS-21-02-118.CrossRefPubMed Raskin KA, Schwab JH, Mankin HJ, Springfield DS, Hornicek FJ: Giant cell tumor of bone. J Am Acad Orthop Surg. 2013, 21: 118-126. 10.5435/JAAOS-21-02-118.CrossRefPubMed
6.
go back to reference Campanacci M, Capanna R, Fabbri N, Bettelli G: Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chir Organi Mov. 1990, 75: 212-213.PubMed Campanacci M, Capanna R, Fabbri N, Bettelli G: Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement. Chir Organi Mov. 1990, 75: 212-213.PubMed
7.
go back to reference Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G: Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 2008, 134: 969-978. 10.1007/s00432-008-0370-x.CrossRefPubMed Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G, Hardes J, Gosheger G: Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol. 2008, 134: 969-978. 10.1007/s00432-008-0370-x.CrossRefPubMed
8.
go back to reference Kivioja AH, Blomqvist C, Hietaniemi K, Trovik C, Walloe A, Bauer HC, Jorgensen PH, Bergh P, Folleras G: Cement is recommended in intralesional surgery of giant cell tumors: a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Acta Orthop. 2008, 79: 86-93. 10.1080/17453670710014815.CrossRefPubMed Kivioja AH, Blomqvist C, Hietaniemi K, Trovik C, Walloe A, Bauer HC, Jorgensen PH, Bergh P, Folleras G: Cement is recommended in intralesional surgery of giant cell tumors: a Scandinavian Sarcoma Group study of 294 patients followed for a median time of 5 years. Acta Orthop. 2008, 79: 86-93. 10.1080/17453670710014815.CrossRefPubMed
9.
go back to reference Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH: Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res. 2011, 469: 591-599. 10.1007/s11999-010-1501-7.CrossRefPubMed Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH: Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res. 2011, 469: 591-599. 10.1007/s11999-010-1501-7.CrossRefPubMed
10.
go back to reference Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS: Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am. 1999, 81: 811-820.CrossRefPubMed Blackley HR, Wunder JS, Davis AM, White LM, Kandel R, Bell RS: Treatment of giant-cell tumors of long bones with curettage and bone-grafting. J Bone Joint Surg Am. 1999, 81: 811-820.CrossRefPubMed
11.
go back to reference Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM: Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002, 397: 248-258.CrossRefPubMed Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, Moreau G, Davis AM: Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002, 397: 248-258.CrossRefPubMed
12.
go back to reference Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, Liu W: Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am. 2012, 94: 461-467.CrossRefPubMed Niu X, Zhang Q, Hao L, Ding Y, Li Y, Xu H, Liu W: Giant cell tumor of the extremity: retrospective analysis of 621 Chinese patients from one institution. J Bone Joint Surg Am. 2012, 94: 461-467.CrossRefPubMed
13.
go back to reference Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU: Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am. 2008, 90: 1060-1067.CrossRefPubMed Becker WT, Dohle J, Bernd L, Braun A, Cserhati M, Enderle A, Hovy L, Matejovsky Z, Szendroi M, Trieb K, Tunn PU: Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy. J Bone Joint Surg Am. 2008, 90: 1060-1067.CrossRefPubMed
14.
go back to reference Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M: Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev. 2010, 36: 1-7. 10.1016/j.ctrv.2009.09.002.CrossRefPubMed Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, Rossi G, Longhi A, Mercuri M: Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev. 2010, 36: 1-7. 10.1016/j.ctrv.2009.09.002.CrossRefPubMed
15.
go back to reference JaVe HL, Lichtenstein L, Portis RB: Giant cell tumor of bone. Its pathologic appearance, grading, supposed variants and treatment. Arch Pathol. 1940, 30: 993-1031. JaVe HL, Lichtenstein L, Portis RB: Giant cell tumor of bone. Its pathologic appearance, grading, supposed variants and treatment. Arch Pathol. 1940, 30: 993-1031.
16.
go back to reference Bieling P, Rehan N, Winkler P, Helmke K, Maas R, Fuchs N, Bielack S, Heise U, Jurgens H, Treuner J, Romanowski R, Exner U, Kotz R, Winkler K: Tumor size and prognosis in aggressively treated osteosarcoma. J Clin Oncol. 1996, 14: 848-858.PubMed Bieling P, Rehan N, Winkler P, Helmke K, Maas R, Fuchs N, Bielack S, Heise U, Jurgens H, Treuner J, Romanowski R, Exner U, Kotz R, Winkler K: Tumor size and prognosis in aggressively treated osteosarcoma. J Clin Oncol. 1996, 14: 848-858.PubMed
17.
go back to reference Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993, 286: 241-246.PubMed Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993, 286: 241-246.PubMed
18.
go back to reference Wulling M, Engels C, Jesse N, Werner M, Delling G, Kaiser E: The nature of giant cell tumor of bone. J Cancer Res Clin Oncol. 2001, 127: 467-474. 10.1007/s004320100234.CrossRefPubMed Wulling M, Engels C, Jesse N, Werner M, Delling G, Kaiser E: The nature of giant cell tumor of bone. J Cancer Res Clin Oncol. 2001, 127: 467-474. 10.1007/s004320100234.CrossRefPubMed
19.
go back to reference Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR: Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 2013, 33: 197-211. 10.1148/rg.331125089.CrossRefPubMed Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR: Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics. 2013, 33: 197-211. 10.1148/rg.331125089.CrossRefPubMed
20.
go back to reference Goldring SR, Schiller AL, Mankin HJ, Dayer JM, Krane SM: Characterization of cells from human giant cell tumors of bone. Clin Orthop Relat Res. 1986, 204: 59-75.PubMed Goldring SR, Schiller AL, Mankin HJ, Dayer JM, Krane SM: Characterization of cells from human giant cell tumors of bone. Clin Orthop Relat Res. 1986, 204: 59-75.PubMed
21.
go back to reference Cowan RW, Singh G: Giant cell tumor of bone: a basic science perspective. Bone. 2013, 52: 238-246. 10.1016/j.bone.2012.10.002.CrossRefPubMed Cowan RW, Singh G: Giant cell tumor of bone: a basic science perspective. Bone. 2013, 52: 238-246. 10.1016/j.bone.2012.10.002.CrossRefPubMed
22.
go back to reference Scully SP, Mott MP, Temple HT, O’Keefe RJ, O’Donnell RJ, Mankin HJ: Late recurrence of giant-cell tumor of bone. A report of four cases. J Bone Joint Surg Am. 1994, 76: 1231-1233.PubMed Scully SP, Mott MP, Temple HT, O’Keefe RJ, O’Donnell RJ, Mankin HJ: Late recurrence of giant-cell tumor of bone. A report of four cases. J Bone Joint Surg Am. 1994, 76: 1231-1233.PubMed
23.
go back to reference Trieb K, Bitzan P, Lang S, Dominkus M, Kotz R: Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy. Eur J Surg Oncol. 2001, 27: 200-202. 10.1053/ejso.2000.1086.CrossRefPubMed Trieb K, Bitzan P, Lang S, Dominkus M, Kotz R: Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy. Eur J Surg Oncol. 2001, 27: 200-202. 10.1053/ejso.2000.1086.CrossRefPubMed
24.
go back to reference Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ: Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone. Clin Orthop Relat Res. 2005, 435: 211-218.CrossRefPubMed Prosser GH, Baloch KG, Tillman RM, Carter SR, Grimer RJ: Does curettage without adjuvant therapy provide low recurrence rates in giant-cell tumors of bone. Clin Orthop Relat Res. 2005, 435: 211-218.CrossRefPubMed
25.
go back to reference Wang HC, Chien SH, Lin GT: Management of grade III giant cell tumors of bones. J Surg Oncol. 2005, 92: 46-51. 10.1002/jso.20338.CrossRefPubMed Wang HC, Chien SH, Lin GT: Management of grade III giant cell tumors of bones. J Surg Oncol. 2005, 92: 46-51. 10.1002/jso.20338.CrossRefPubMed
26.
go back to reference Malek F, Krueger P, Hatmi ZN, Malayeri AA, Faezipour H, O’Donnell RJ: Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy. Int Orthop. 2006, 30: 495-498. 10.1007/s00264-006-0146-3.CrossRefPubMedPubMedCentral Malek F, Krueger P, Hatmi ZN, Malayeri AA, Faezipour H, O’Donnell RJ: Local control of long bone giant cell tumour using curettage, burring and bone grafting without adjuvant therapy. Int Orthop. 2006, 30: 495-498. 10.1007/s00264-006-0146-3.CrossRefPubMedPubMedCentral
27.
go back to reference Szendroi M, Kiss J, Antal I: Surgical treatment and prognostic factors in giant-cell tumor of bone. Acta Chir Orthop Traumatol Cech. 2003, 70: 142-150.PubMed Szendroi M, Kiss J, Antal I: Surgical treatment and prognostic factors in giant-cell tumor of bone. Acta Chir Orthop Traumatol Cech. 2003, 70: 142-150.PubMed
28.
go back to reference Krishnan EC, Nelson C, Neff JR: Thermodynamic considerations of acrylic cement implant at the site of giant cell tumors of the bone. Med Phys. 1986, 13: 233-239. 10.1118/1.595902.CrossRefPubMed Krishnan EC, Nelson C, Neff JR: Thermodynamic considerations of acrylic cement implant at the site of giant cell tumors of the bone. Med Phys. 1986, 13: 233-239. 10.1118/1.595902.CrossRefPubMed
29.
go back to reference Nelson DA, Barker ME, Hamlin BH: Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia. 1997, 13: 287-306. 10.3109/02656739709023537.CrossRefPubMed Nelson DA, Barker ME, Hamlin BH: Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia. 1997, 13: 287-306. 10.3109/02656739709023537.CrossRefPubMed
30.
go back to reference Sakayama K, Sugawara Y, Kidani T, Miyawaki J, Fujibuchi T, Kamei S, Aizawa J, Yamamoto H: Diagnostic and therapeutic problems of giant cell tumor in the proximal femur. Arch Orthop Trauma Surg. 2007, 127: 867-872. 10.1007/s00402-007-0419-3.CrossRefPubMed Sakayama K, Sugawara Y, Kidani T, Miyawaki J, Fujibuchi T, Kamei S, Aizawa J, Yamamoto H: Diagnostic and therapeutic problems of giant cell tumor in the proximal femur. Arch Orthop Trauma Surg. 2007, 127: 867-872. 10.1007/s00402-007-0419-3.CrossRefPubMed
Metadata
Title
Local control of giant cell tumors of the long bone after aggressive curettage with and without bone cement
Authors
Zhen-hua Gao
Jun-qiang Yin
Xian-biao Xie
Chang-ye Zou
Gang Huang
Jin wang
Jing-nan Shen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-330

Other articles of this Issue 1/2014

BMC Musculoskeletal Disorders 1/2014 Go to the issue